The Hand Therapy Certification Commission, Inc., in consultation with the Professional Examination Service, completed a practice analysis of hand therapy in 2001. One goal was to obtain information about the competencies shown by therapists at specific points of experience. Six competency areas were identified and included in the final survey: scientific knowledge, clinical judgment/clinical reasoning, technical skills, interpersonal and communication skills, professionalism, and resource management. Certified Hand Therapists (CHTs) in the United States and Canada participated in the survey. All six competencies were rated moderately or highly critical to professional effectiveness. Thirty hypothesized behavioral progressions (from novice to expert) were included; 27 were validated by the results, indicating that CHTs show competence that is unique and increases over time. Potential uses of these results by CHTs and hand therapy organizations are proposed, especially in regard to candidate eligibility, self-assessment by CHTs, and planning for continuing education.